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General NPI Number Information
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NPI Number | 1679394308
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Entity Type | Organization
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Legal Business Name | LB MEDICAL CONSULTANTS
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 32 S 150 E
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City | BURLEY
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State | ID
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Zip | 83318-5450
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Country | US
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Telephone | 208-207-9422
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Fax | 208-269-5828
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Provider Business Mailing Address
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Address Line | PO BOX 43
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City | TWIN FALLS
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State | ID
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Zip | 83303-0043
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Country | US
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Telephone | 208-738-3446
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Fax | 208-269-5828
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE DAWN BARTLETT
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Credential | DNP
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Telephone | 208-207-9422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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